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IIIIIII111111111 <br /> STATE OF COLORADO <br /> DIVISION OF MINERALS AND GEOLOGY <br /> Department of Natural Resources <br /> 1313 Sherman St Room 215 /y A, <br /> Denver,Colorado 80203 <br /> Phone ( 67 <br /> FAX:(303)3t 832-8102-8106 G <br /> DEPARTMENT ETF <br /> APR 2 2 1999oN,,AIle, NATURAL <br /> CONSTRUCT% T TERIA S S� RESOURCES <br /> (A 112) OPERATION <br /> koy Romer <br /> RE V1fr ION PERMIT APPLICATION FORM Governor <br /> James S.Lochhead <br /> Executive Director <br /> Michael B.Long <br /> Division Director <br /> CHECK ONE: X New Application (Rule 1.4 .5) Amendment Application (Rule 1.10) <br /> Conversion Application (Rule 1.11) <br /> Permit O -_ (provide for Amendments and Conversions of existing <br /> permits) <br /> The application for a Construction Materials Regular 112 Operation Reclamation Permit contains <br /> three major parts: (1) the application form; (2) Exhibits A-S, Addendum 1, any sections of <br /> Exhibit 6.5 (Geotechnical Stability Exhibit; and (3) the application fee. When you submit your <br /> application, be sure to include one (1) complete sinned and notarized IVORY ORIGINAL and four (4) <br /> copies of the completed Ivory application form, five (5) copies of Exhibits A-S, Addendum 1, <br /> appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for the application fee <br /> described under Section (4) below. Exhibits should NOT be bound or in a nder; maps <br /> should be folded to 8 112" X 11" or 8 1/2" X 14" size. To expedite processing, please provide <br /> the information in the format and order described in this form. <br /> ------------ <br /> GENERAL OPERATION INFORMATION <br /> Type or print clearly, in the space provided, ALL information requested below. <br /> --------------------------------------------------------------------------------------------- <br /> 1. Applicant/operator or company name (name to be used on Permit) : <br /> Connell Resources <br /> 1. 1 Type of organization (corporation, partnership, etc. ) : General Contractor <br /> 1.2 I.R.S. Tax I.D. No. or Social Security Number: 84-OSS841 <br /> 2. Operation name (pit, mine or site name) : Tirlmath Connell Pit <br /> 3. Permitted acreage (new or existing site) : permitted acres <br /> 3.1 Change in acreage (+) acres <br /> 3.2 Total acreage in Permit area 1S7.S8 acres <br /> 4. Fees: <br /> 4.1 New Application $1, 875.00 application fee <br /> 4 .2 New Quarry Application $2, 325.00 quarry application <br /> 4.3 Milling Application (Non-DMO) $3, 100.00 milling application <br /> 4 .4 Amendment Fee $1, 550.00 amendment fee <br /> 4 .5 Conversion to 112 operation (set by statute) $1, 875.00 conversion fee <br /> 5. Primary commoditie(s) to be mined: Sand Gravel <br /> f 5.1 Incidental commoditie(s) to be mined: 1. N/A lbs/Tons/vr <br /> 2. / lbs/Tons/vr 3. / lbs/Tons/vr <br /> 4 . / lbs/Tons/yr 5. / lbs/Tons/yr <br /> 5.2 Anticipated end use of primary commoditie (s) to be mined: Construction Dlaterial <br /> 5.3 Anticipated end use of incidental commoditie (s) to be mined: N/A <br />